Medicaid

The Center for Health Care Strategies has released a report exploring the benefits of developing Health-Related Social Needs (HRSN) interventions that address the medical, behavioral, and social components of health for Medicaid enrollees. The report examines the need for community-based organizations (CBOs) that specialize in social care, such as food and housing services, to partner with health care organizations (HCOs) to provide more equitable, whole-person care. Drawing from leading-edge state Medicaid programs that require formal CBO-HCO partnerships, the report provides best practices and implementation considerations for other states interested in strengthening CBO-HCO relationships.

This report is the most comprehensive and representative assessment of self-reported outcomes among older adults and people with physical disabilities receiving publicly funded LTSS since 2018. These data were collected from 13,663 people between June 2021 and July 2022. The sample includes individuals from 15 regionally representative states and a variety of LTSS programs, including: Medicaid HCBS, Nursing Facilities, and Older Americans Act recipients.

On Tuesday, March 28th, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of December 2022, over 65.2 million people are enrolled in Medicare; more than 35 million are enrolled in fee-for-service Medicare and over 30.2 have a Medicare Advantage plan. Over 91.3 million enrollees have Medicaid and CHIP; more than 84.3 million individuals have Medicaid and over seven million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

The Center for Health Care Strategies recently released several new resources all centering around how to better support older adults with the Multi Sector Plans for Aging (MPA). A multisector plan for aging refers to the multi-year planning and execution process that brings together partners to address the needs of the older adult population in a state. Some of the new resources include strategies for first steps and development of a MPA, advice and best practices from states with MPAs in place, and how family caregiving can help shape a states MPA.

KFF’s analysis released March 2, 2023, “Medicaid Enrollment Growth: Estimates by State and Eligibility Group Show Who may be at Risk as Continuous Enrollment Ends”, presents findings from the organization’s evaluation of Medicaid and Children’s Health Insurance Program (CHIP) enrollment data. KFF estimates nearly 95 million people enrolled in Medicaid and CHIP in March 2023 – an increase of 23.3 million enrollees with over half of the enrollee increase among adults under age 65 and nearly one-third among children. Also, five states – California, New York, Texas, Florida, and Illinois – comprise over one-third of the increase in Medicaid and CHIP enrollment while the rate of growth in enrollment varies among states.

On Tuesday, February 21, 2023 The Association of Community Affiliated Plans, Medicaid Health Plans of America, and Sellers Dorsey released their highlights from the 2022 State of Medicaid Managed Care Report. The report covered five core areas of managed care across the country, the current state of managed care, the history of federal regulations and key changes, effective approaches from six states, innovations and successes from MCOs, and outcomes stemming from managed care.

A new issue brief from Kaiser Family Foundation shares how States can work with Medicaid managed care organizations (MCOs) to prepare beneficiaries for the unwinding process. MCOs deliver to more than two thirds of Medicaid beneficiaries nationally and this article shares insight on the strategic partnerships between states and their MCOs to prepare for the unwinding process.

The Center for Health Care Strategies released a blog post covering best practices and advice for creating a multidisciplinary and multi sector plan for aging. The post was authored by Kim McCoy Wade, senior advisor of Aging, Disability, and Alzheimer’s to the California governor. The post dissects the planning process for creating a multi sector plan for older adults and people with disabilities and how to work with multiple stakeholders all vying to reach the same goal.

The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) have released an updated data book which presents information on the demographic and other personal characteristics, expenditures, and health care utilization of individuals who are dually eligible for Medicare and Medicaid coverage.

On Monday, January 31st, CMS issued a final rule for the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. The MA RADV program is used to identify improper risk adjustment payments made to Medicare Advantage Organizations (MAOs) for claims made to Medicare without supporting evidence from a beneficiary’s medical record. Payments to MAOs are adjusted based on the health status of a MAO’s enrollees using medical diagnoses reported by the insurer. The new policy will apply to plan contracts since 2018.